A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women.

OBJECTIVE

To establish whether women's preference for elective caesarean section (ELCS) changes as gestation advances.

DESIGN

A prospective longitudinal observational study.

SETTING

Two units providing obstetric care in Hong Kong, one public and one private.

SAMPLE

Five hundred and one nulliparous Chinese pregnant women attending their routine fetal anomaly scan in either unit.

METHODS

Consented subjects had two interviews using a structured questionnaire at 18-22 weeks and 35-37 weeks of gestation, respectively. Multivariate analysis was performed to identify determinants for preferring ELCS at the two gestational ages.

MAIN OUTCOME MEASURE

The preferences for the mode of delivery at the two gestational ages.

RESULTS

The prevalence of maternal preference for ELCS in the study cohort was 17.2% (95% CI 13.9-20.5) and 12.7% (95% CI 9.6-15.8) at mid-trimester and at term, respectively. Significantly more women who preferred ELCS at mid-trimester changed to a trial of vaginal delivery (VD) at term than vice versa (42.0 versus 3.8%). The partner's preference for ELCS was a significant determinant for women preferring ELCS throughout the antenatal period. Among the women booked in the public sector, more women who preferred ELCS at term changed to deliver in private hospitals than those who preferred VD (46.2 versus 9.7%).

CONCLUSIONS

Many women changed from preferring ELCS to preferring VD as their pregnancy approached term. The partner's preference was a significant determinant for the women's choice. If a decrease in the proportion of women preferring ELCS is desired, the intervention programme should target the women and their partners who hold such a preference at 20 weeks.